Key words: epidemiology, symptom, etiology, risk factor, complication, diagnosis, treatment, prevention, myth. 

1. Singaporean Flu, does not attack
only the Singapore
Prof Ariyanto Harsono MD PhD SpA(K)

2. Introduction
"Singaporean Flu" is not listed in the ICD
diagnosis. The actual name is: "Hand Foot and
Mouth Disease" (HFMD). In Indonesia is called
Singaporean Flu for the first time outbreak in
Singapore. After then outbreak in some parts of
Asia and parts of Australia and Africa occurred.
Prof Ariyanto Harsono MD PhD SpA(K)
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3. There are other diseases that are similar but not the
same:"Foot and Mouth Disease" is sometimes called "Hoof
and Mouth Disease", which is an infectious viral disease
found in cattle that cannot be passed from pets or other
animals to humans, and are not from human infect
animals.
HFMD is a mild disease that causes only a few days of fever
and other signs and symptoms are relatively mild. But if
mouth sores or sore throat should keep children drink
adequate fluids. Need to contact doctor if after a few days,
the signs and symptoms worsen.
Key words: epidemiology, symptom, etiology, risk factor, complication,
diagnosis, treatment, prevention, myth.
Prof Ariyanto Harsono MD PhD SpA(K)
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4. Epidemiology:
The disease is highly infectious and often occurs in the summer.
HFMD is a disease that often occurs in dense groups and affects
children aged 2 weeks to 5 years (sometimes up to10 years).
Adults are generally more resistant to entero viruses, although it
could be affected.
Transmission through the faecal-oral (digestion) and respiratory
tract, i.e. from droplets (droplets of saliva), runny nose, saliva,
feces, fluid vesicles (skin disorders such as tiny bubbles filled with
fluid) or excreta. Indirect contact transmission through the goods,
towels, clothes, food equipment, and toys that are contaminated
with secretions. But there is no vector (carrier) such as flies and
cockroaches.
It gives specific disease immunity, but the child may be exposed
to viruses HMFD again by other entero-virus strains.
Prof Ariyanto Harsono MD PhD SpA(K)
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5. Symptoms of Disease
The incubation period is three to seven days.
Fever is often the first sign, followed by a sore
throat and sometimes a lack of appetite and
malaise. One or two days after the fever begins,
painful sores can occur in the mouth or throat.
Rashes on the hands and feet and possibly on
the buttocks can follow within a day or two
Prof Ariyanto Harsono MD PhD SpA(K)
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6. Prof Ariyanto Harsono MD PhD SpA(K)
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7. Begin as small red spots that blister and then often become
ulcers on the tongue, gums and inside the cheeks.
Prof Ariyanto Harsono MD PhD SpA(K)
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8. Skin rash starts out as flat, red spots that turn into blisters may
also appear after one or two days.
The rash does not itch, and usually appear on the palms and soles
of the feet.
HFMDcan cause some or all of the signs and symptoms of the
following:
•Fever
•Sore throat
•feeling unwell (malaise)
•Pain, red, blister-like lesions on the tongue, gums and inside of
cheek
•red rash, no itching but sometimes with pain, in the palms, soles
and sometimes buttocks
•Irritability in infants and toddlers
•Loss of appetite
Prof Ariyanto Harsono MD PhD SpA(K)
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9. Etiology
The most common cause of HFMD is coxsackie
virus A16 infection. A group of viruses including
enterovirus coxsackie virus non polio. Other
entero viruses can sometimes cause, there are
reports of isolation of some strains of
enterovirus 71 in outbreaks of disease.
Prof Ariyanto Harsono MD PhD SpA(K)
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10. coxsackie virus A16
Prof Ariyanto Harsono MD PhD SpA(K)
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11. A child who previously infected so it can be a carrier and continues to be a
source of infection for other children, spread the virus, even if he has
recovered well.
Oral transmission is the main source of coxsackie virus infection. The disease
is spread by person-to-person when an infected person is:
•Nasal secretions or throat swabs
•Saliva
•Fluid from the blisters
•Feces
•Sprays breathing air after coughing or sneezing
Commonly occurs in child day care.
Although most contagious during the first week of illness, the virus can
remain in the body for weeks after the signs and symptoms disappear. That
means children can still infect others.
Some people, especially adults, can transmit the virus without showing any
signs or symptoms of disease.
Outbreaks of this disease is more common in summer and autumn in the
United States and other temperate regions. In tropical climates, outbreaks
occur throughout the year.
Prof Ariyanto Harsono MD PhD SpA(K)
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12. Risk factors
HFMD mainly affects children younger than age
10. Children in child care centers are particularly
vulnerable to outbreaks because the infection
spread by person-to-person, and children are
the most vulnerable. Children usually have
immunity to the disease as they get older to
build antibodies after exposure to the virus that
causes the disease.
Prof Ariyanto Harsono MD PhD SpA(K)
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13. Complication
HFMD’s most common complication is dehydration. This disease
can cause sores in the mouth and throat, making swallowing
painful and difficult.
HFMD is usually a mild illness that causes only a few days of fever
and other signs and symptoms are relatively mild. However, a
rare form and coxsackie virus sometimes serious complications to
the brain and can cause:
•Viral meningitis. It is an infection and inflammation of the
membranes (meninges) and cerebrospinal fluid that surround the
brain and spinal cord, usually mild and self-limiting.
•Encephalitis. This severe disease and potentially life-threatening
inflammation involving the brain caused by a virus, but
encephalitis is rare.
Prof Ariyanto Harsono MD PhD SpA(K)
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14. Tests and diagnosis
To distinguish disease from other types of viral
infection by evaluating:
•The pattern of signs and symptoms
•The emergence of a rash or sores
A throat swab or stool specimen may be taken
and sent to a laboratory to determine which
virus caused the disease, can only be done at
the Great Hospital.
Prof Ariyanto Harsono MD PhD SpA(K)
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15. Care and Treatment
There is no specific treatment for HFMD. Signs and symptoms of the disease
usually resolves in seven to 10 days.
To help reduce the discomfort, it is recommended:
•Rest
•Drinking milk-based fluids may be easier than liquid acids, such as juice or soda
•Drinking pain killer other than aspirin, such acetaminophen or ibuprofen, if
necessary, but not necessary for mild fever
•Using mouth wash or oral spray to reduce pain mouth/throat. Certain foods and
drinks can irritate the blisters on the tongue or in the mouth or throat. Try these
tips to help make the pain less intrusive and more tolerable eating and drinking:
•Eating ice cream or sherbet
•Drink cool beverages, such as milk or ice water
•Avoid acidic foods and beverages, such as fruit juice, fruit drinks and soda
•Avoid salty or spicy foods
•Eat soft foods that do not require much chewing
•Rinse mouth with warm water after a meal
Prof Ariyanto Harsono MD PhD SpA(K)
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16. Prevention
Certain precautions can help reduce the risk of infection:
•Wash hands carefully. Be sure to wash hands frequently and
thoroughly, especially after using the toilet or changing
diapers, and before preparing food and eating. When soap
and water are not available, use hand wipes or gel alcohol.
•Teach good hygiene. Show the children how to practice
good hygiene and how to keep self clean. Explain to them
why it's best not to put their fingers, hands or other objects
in the mouth.
•Isolate infectious person. Because the disease is highly
contagious, people with the disease should limit their
exposure to others while they have signs and symptoms of
active disease.
Prof Ariyanto Harsono MD PhD SpA(K)
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17. Myths and Facts About Flu Singapore
1. Myth: Children with flu Singapore banned bath. Fact: in
order to speed up the healing process, the body of the
child should be clean by bathing.
2. Myth: Children with the Singapore flu should wear
powder, so bump-bump in his body disappear fast. Fact:
The powder can be deposited on the wounds, so can be
contaminated by other virus such as chicken pox which
can slow the healing process.
3. Myth: Exposure to wind can exacerbate children with
Singapore flu. Fact: a gust of wind will not aggravate the
health conditions of children, but can transmit flu to
others.
Prof Ariyanto Harsono MD PhD SpA(K)
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18. Thank you
Prof Ariyanto Harsono MD PhD SpA(K)
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